Dear DOCTOR Owen:

I have binge eating disorder. I eat to excess, cannot stop, and will go on for days eating and drinking (soft drinks) everything in site. I have tried everything to stop—read books on it and have gone through psychotherapy— and I still eat like a hog for days. I am willing to go through surgery or take medications. What can I do?

Hog Wild

Dear “Wild”:

In its Diagnostic Manual, the American Psychiatric Association now classifies binge eating disorder as a definable condition. It is considered similar to other compulsive disorders because people know they are engaging in harmful behavior and make a conscious, planned effort to stop, but are unable to stay focused and fail to discontinue their behavior. People with this disorder have unusual food attitudes, definable personality traits, and depressive symptoms.

Many compulsive disorders now are being treated successfully with combinations of medication and counseling. Medication has been amazingly successful when counseling alone hasn’t worked, which points to a chemical abnormality in the brain that contributes to the condition.

Researchers at Albany Medical College, reporting in Obesity Research, Vol. 7 (5), 469–476 (1999), compared drug treatment outcomes in binge and non-binge obese subjects. The subjects in two groups were treated with medication that affected two major chemicals in the brain: serotonin and norepinephrine.

The people in both groups lost comparable amounts of weight. However, test scores of the binge eaters showed a significant improvement in overcoming the disorder. Their scores and behavior remained controlled until the medication was discontinued; then the symptoms and behaviors returned with uncontrolled eating and weight gain.

As many as 30% of patients in medical Diet Therapy clinic programs, such as mine, test with scores that are compatible with binge eating disorder. In general, binge eating disorder patients are much heavier than the average patient. They clearly respond to medication, just as might a depressed person.

A number of medications exist, which could benefit this condition. Commonly used approved medications include Wellbutrin SR®, Meridia®, Phentermine, all of the serotonin antidepressants (Prozac, Zoloft®, Paxil®, Effexor, Celexa), and the more traditional antidepressants that affect norepinephrine.

Structured diet methods and individual or group counseling are also vital avenues for these patients, who feel isolated and hopeless, and have a syndrome of failure. Group interaction, for instance, helps them realize that they are not alone; see and express hope; and solve problems with methods—not emotion.

Those of us who treat obesity realize that there are many contributing conditions to each individual case. Therefore, in order to be effective, treatment must be evaluated on an individual basis. Getting together in a group and clapping when someone loses 3 pounds does nothing to help a person such as you. If anything, it may make you feel even more abnormal and isolated. When a 20-pound overweight person seems to be in control and talking bathing suits, for example, you can’t relate. I certainly understand why.

If you are more than 30 pounds overweight or have a medical condition caused or contributed by diet and weight, get evaluated by someone with expertise in obesity treatment. Physicians with experience in this area are rare. However, most registered dietitians have some training in recognizing these disorders and may have advice as to where to seek help.

Just knowing that you have a definable, treatable condition can help remove self-imposed stigma and mental barriers. Drug therapy may need to be given for extended periods— possibly forever. Please get over the notion that your problem is one of mind over matter. This is not a character flaw; it is a chemical (brain chemicals) issue.